Intro

Process

Validation

Results

Intro

The check-in interaction between a patient and a clinic usually starts after scheduling an appointment. Almost every clinic visit requires completing electronic forms on an iPad, which is a part of check in process. In this project we concentrated on the improvements of this interaction.

Pain Points

Patient

  • The number of iPad is limited

  • Patients need to wait for a free iPad, which increases the check-in time

  • iPad is a public device, that means touching dirty screen

  • Personal information can be seen by anyone standing behind

Clinic

  • iPad is an expensive device which clinics have to buy and update

  • iPad self check-in mode set up and updates requires constant trainings for clinic staff

  • Manual work by receptionists to select needed forms to fill out may cause errors

Goal

Provide solution for more convenient patient check-in while reducing overall clinic hardware costs - fewer iPads required.

Business Opportunity

  1. Considering the fact that 85% of Americans own smartphones (according to Pew Research Center) we can implement a so called “Bring Your Own Device” project as a smart solution to getting a patient into the doctor's office faster.

  2. Provide the ability for patients to fill in the forms in advance via email and/or text message.

Solution

  1. Check-in with your own device via QR code or SMS

  • Faster - no need to wait for a free iPad

  • More secure - safe, clean and convenient

  • Easy - no logins, portals or apps to install, extra setup needed

  • Cheaper - less iPads for reception desk to buy

2. Appointment Confirmation

In an email / text message there is a possibility to confirm and cancel an appointment and complete the forms needed for the visit.

Metrics

  1. Check-in via mobile

Percentage of check-ins via mobile devices compared to all check ins and kiosk check-ins
NPS Score (Patient Satisfaction)

2. Appointment Confirmation

  • No show rate for clinic with compared to clinic w/o appointment confirmation

  • The number of confirmations

  • Not responded to responded rate

Process

Pre Check-In

Prior to an appointment a patient will receive an email with ability to:

  • Confirm appointment

  • Cancel appointment

  • Reschedule appointment

I designed the email after the research I had conducted before. You can find the results of the research in this article on Medium. 

*We have 2 confirm appointment actions being performed twice (on an email and on a separate screen) because antiviruses can click on URLs received via email. It results in appointments automatically confirmed/declined.

The rescheduling case appeared to be a little bit tricky to implement fast, so it was postponed.

Check-In

A patient check-in via mobile device can be performed in 2 ways: via SMS or after scanning a QR code:

  1. Patient scans a QR code or comes to reception and a receptionist sends her an SMS with a link to check-in form located in the reception area

  2. Patient proceeds to the waiting area and fills-in all forms

    • In the backend side demographic data which was entered by the patient is matched with existing patient profiles and appointments in the clinic for today. In case there are several appointments, patients will see them all. 

  3. When a patient submits forms, MA gets a notification via EHR and comes to greet the patient

*In the future iterations we could change the verification process by providing the possibility to verify via SMS verification code, so that the only data a patient should enter is the phone number and code that they will receive after. 

The Poster has to be printed and put on the wall. It should include:

  • Clinic logo to make you comfy and secure

  • Giant QR code you can’t miss

  • Old-school link if you don’t have QR scanner

In order to give clinic staff the ability to print ready to use QR code I designed an interface in the clinic settings, where it is possible to:

  1. Add several clinics (it could be different departments) which can use the same QR code

  1. Edit the text on the welcome screen after the QR code scanning

  2. Generate the code, download a code itself and a poster

Validation

I chose the next goals to investigate during the validation with users:

  1. Explore how people react on check-in using their own phone

  2. Find out which method of filling out the form (via a text message (SMS) or QR code scanning) is better for users

  3. Check if QR code poster instructions are obvious for patients

  4. Investigate the end-to-end flow from the moment of email notification to the actual visit

Study assumptions:

  1. Appointment Confirmation email meets users’ expectations for such kinds of notifications

  2. People find check-in with own devices more private

  3. QR code poster is clear and easy-to-use

  4. Patients prefer SMS to QR Code (more traditional)

  5. Both options are good to have in clinics

Participants:

Total

  1. 4 male

  2. 5 female

Age

  1. 4 people: 40-45

  2. 4 people: 30-34

  3. 1 person: 16

Countries

  1. 5 people: Ukraine

  2. 2 people: Nigeria

  3. 1 person: Great Britain

  4. 1 person: Cameroon

Feedback

1

Email

Good

In general, everyone likes emails that are:

  1. Easy-to-use

  2. Clear and intuitive

  3. Fully meet expectations

Needs improvement

  1. Provide more details of the clinic location

  2. Add ability to reschedule an appointment

  3. Add alt attribute to the <img> tag that will be displayed if the image failed to load

2

Notification Channel

It turned out that 5 from 9 preferred SMS:

  1. Works offline

  2. Can’t miss it

  3. Doesn’t require any mail program

  4. More reliable

3

SMS vs QR Code

SMS +

  1. More personalized

  2. Trackable, you can see the history on your mobile phone

  3. You still have it on your phone if there is no Internet connection

OR Code +

  1. Link to the form on the QR code poster is a good idea

  2. Faster than SMS

  3. Perfect option for the first check-in (just to confirm that you’ve arrived to the clinic), but not for survey taking

SMS -

  1. More time-consuming (you need to read text) 

  2. Can be delayed due to the mobile operator problems

  3. Seems outdated as compared to QR Code

OR Code -

  1. Users lack confidence in using it

  2. Some visual instructions below the QR code can be added (e.g., how to scan)

  3. Find scanning the QR code not very convenient

Users' concerns

  1. Can lead to a wrong page with some insecure content

  2. Is more appropriate for financial purposes than health issues

Overall Feedback:

" Is better than having to talk with clinic staff — sick people don’t feel like talking to someone "

" Is better than having to talk with clinic staff — sick people don’t feel like talking to someone "

" Is better than having to talk with clinic staff — sick people don’t feel like talking to someone "

All the results were gathered into affinity diagram

SUS Score = 81,9

SUS Score = 81,9

SUS Score = 81,9

Results

After the implementation of the functionality in real clinics QR code check-in became the most frequently used check-in method. The implementation of this functionality coincided with the beginning of Covid 2019, so QR code check in proved its necessity.

For check-in via mobile:

  1. Percentage of check-ins via mobile devices compared to all check-ins and kiosk check-ins became 40% to all and 80% to kiosk check-ins

  2. NPS (Patient Satisfaction) - different for different clinics but overall it was raised by 15% on average

For appointment confirmation emails:

  1. No show rate for a clinic with compared to a clinic w/o appointment confirmation became 40 to 20%

  2. The number of confirmations raised to 60%

  3. Not responded to responded rate became significantly larger for notification via SMS rather than for email - 80% to 50%